Consent for Minors Form

"*" indicates required fields

Parent or Legal Guardian First Name*
Parent or Legal Guardian Last Name*

Children under the age of 18 may receive massages and/or body therapies by a Licensed Massage Therapist at Bella Via Skin and Body Therapies. The child’s parent or legal guardian must sign a consent form, and a Body Therapy form must be completed by the child/dependent and/or parent/legal guardian prior to the service being performed. The parent or legal guardian is always welcome to be present in the treatment room during the session. It is recommended that a parent or legal guardian be present in the treatment room or waiting room area during the session for children under the age of 16.